It was a banner year for fraud and abuse investigators, according to the recently released annual report of the Health Care Fraud and Abuse Control Program.
HHS and the Department of Justice stepped up fraud and abuse investigation efforts in 1997, fueled by the 1996 Health Insurance Portability and Accountability Act. The act gave investigators new criminal and civil enforcement powers and $104 million in dedicated resources. It also increased the HHS investigative staff to 1,143 from 900, and funded six new investigative offices and three new audit offices under the Office of the Inspector General. Funding for an additional six investigative offices will be available this year.
During the first full year of anti-fraud investigations under the HIPAA -- 1997 -- almost $1.9 billion was collected in criminal fines, civil judgments and settlements. About $970 million, or almost 90% of the recovered money, was returned to the Medicare Trust Fund, and Medicare coverage reviews in 19 states found overpayments of $87.6 million. More than 2,700 people were taken out of federally sponsored healthcare programs, up 93% from 1996, according to the report.
In addition, federal prosecutors filed 282 criminal indictments in healthcare fraud cases, a 15% increase over 1996. And the number of civil healthcare actions increased 61%, to 4,010.
The government considers the severity of the result and the offender's objectives in determining whether a case is a criminal or civil matter. Punishment for criminal matters may include fines, jail terms, repayment requirements and suspension from Medicare and Medicaid programs.